Genetic basis of aminoglycoside resistance following changes in aminoglycoside prescription patterns

Aminoglycosides (AG) offer an important therapeutic option for the treatment of infections caused by multiresistant Enterobacteriaceae. We observed a change in AG usage patterns in our institution between 1997 and 2006, namely a reduction in use of all AG except amikacin. We studied the changes in AG susceptibility rates in these time periods and correlated with prevalence of different molecular resistance mechanisms. Enterobacteriaceae isolated from blood cultures from 1997 and 2006 were studied. Susceptibilities to AG were determined with the disk diffusion method. PCR was used to detect genes encoding AG-modifying enzymes and methylases. Gentamicin resistance rates dropped from 14·5 to 8·8%, whereas resistance rates to other AG remained unchanged. The AAC(6')-I+AAC(3)-I combination was more common in 1997, whereas AAC(6')-I was the most common mechanism in 2006. Reduction in gentamicin use may preserve the usefulness of this agent against severe infections by multiresistant bacteria such as carbapenemase-producing Enterobacteriaceae.